Provider Demographics
NPI:1811002116
Name:BOBBA, SHARDA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHARDA
Middle Name:K
Last Name:BOBBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E. TOWN ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-221-0621
Mailing Address - Fax:614-221-0829
Practice Address - Street 1:393 E. TOWN ST
Practice Address - Street 2:SUITE 228
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-221-0621
Practice Address - Fax:614-221-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-48302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH071-5659Medicaid
OHB00622152Medicare ID - Type Unspecified
OH071-5659Medicaid